2. HARM REDUCTION Bogotá November 2008

3. The Czech Republic in the heart of Europe

4. The British vs. American Models in history Drug addiction is illness Drug addiction is illness Medical model: based on controlled dispensation of drugs to addicts Medical model: based on controlled dispensation of drugs to addicts Services are primaraly Harm reduction orianted Services are primaraly Harm reduction orianted In favour of prescribing common drugs (e.g. Diamorphin/heroin) as part of treatment In favour of prescribing common drugs (e.g. Diamorphin/heroin) as part of treatment Discussing liberalisation of cannabis and permit its medical use Discussing liberalisation of cannabis and permit its medical use Drug use is a criminal activity Criminal justice model: based on repression and punishment Services are primaraly abstinence orianted Needle exchange programs are not on official agenda Prescribing drugs (e.g. heroin) as part of treatment is an “undesirable development” “War on drugs” Harsh punishment even for minor possesion of cannabis The American Model The British Model

5. Percentage drug use in the UK (16-24 year-olds) 19972002/32003/42004/52005/62006/7 Any drug31.828.528.326.525.224.1 Cannabis28.226.225.323.621.420.9 Cocaine3.25.25.45.15.96.1 Ecstasy5.15.85.54.94.34.8 Amphetamines9.93.84.03.23.33.5 Hallucinogens3.42.22.93.03.43.1 LSD3.20.90.90.50.90.7 Heroin0.30.20.40.20.20.2 Methadone0.10.20.300.10.1 1 Source: Home Office Statistics Bulletin, Crime in England and Wales 2006/07

6. Percentage drug use in the US (16-24 year-olds) 20012002200320042005 Any drug53.953.051.151.150.7 Cannabis49.047.846.145.745.3 Cocaine3.73.83.63.73.7 Ecstasy11.710.58.37.57.1 Methamphetamines-6.76.26.26.3 LSD10.98.45.94.63.9 Heroin1.81.71.51.51.6 Tranquilizers10.311.410.210.610.9 Inhalants13.011.711.210.99.9 1 Source: NIDA report, 2006, Lifetime prevalence

7. European model today Integrating both abstinence and Harm Reduction model = services run different programs = indication for sevices/interventions depend on: Integrating both abstinence and Harm Reduction model = services run different programs = indication for sevices/interventions depend on: —Good assassment of individual client situation = case management – work with a care plan in the community —Possibility of (clients) choice Client has a right to be the co-author Client has a right to be the co-author Drug demand reduction policy/strategy has to reflect the need of: Drug demand reduction policy/strategy has to reflect the need of: —Service Users —Service Providers —Service Donars Funding being redirected from drugs suply reduction to drug demand reduction Funding being redirected from drugs suply reduction to drug demand reduction

8. European model - Pragmatic measures for prevention of HIV- AIDS among IDUs Early secondary prevention – dealing with the syndrom of the hidden population (low number of problematic drug users come to services alone Early secondary prevention – dealing with the syndrom of the hidden population (low number of problematic drug users come to services alone Pragmatic policy - harm-reduction orientated (including prescribing programmes, out reach work and low threshold services) Pragmatic policy - harm-reduction orientated (including prescribing programmes, out reach work and low threshold services) Networking - working with/through differences Networking - working with/through differences Community cooperation Community cooperation Multidisciplinary approach Multidisciplinary approach Information campaign aimed at Information campaign aimed at  Drugs awareness = lowering risk behaviour  Challenging the public attitude towards IDUs and HIV positive people

9. Theoretical backround Drug problem is bio-psycho-social (BPS) problem Drug problem is bio-psycho-social (BPS) problem Out of 100% of people who tried drugs, only 10% get to chronical stage Out of 100% of people who tried drugs, only 10% get to chronical stage There are two significant subgroups There are two significant subgroups —Primary mental health problems —Socialy deprivated and/or excluded group

10. Theoretical backround BPS model Assessment – proces of drug problem development: Assessment – proces of drug problem development: —History of a drug use —Stages of drug problem —Development of awareness of the drug problem —Comorbid problems —Indication to efective intervention

11. Theoretical backround – BPS model What do we work with when we say a drug problem? Is it only drug addiction? What do we work with when we say a drug problem? Is it only drug addiction? —Withdrawal – physical addiction —Craving - psychological —Flashbacks —Overdoses —Social context issues – changes in traditional social structure = family, education, job situation, peer enviroment/socialising —Chaotic life style —Criminal behavior —Risky behavior in drug use, sex… —“Spiritual emptyness…”

12. Theoretical backround – forms of interventions Medical Medical Psychological Psychological Educational Educational Social Social Self-support Self-support Spiritual Spiritual

13. Specific services Spiritual support Spiritual support Skills learning center – regarding a job market Skills learning center – regarding a job market Prison services Prison services Self help groups, users forum Self help groups, users forum Training institute – IES Training institute – IES

14. Our values… Regard for human life Regard for human life Assistance and support for people Assistance and support for people Primary human ethical principles based on the European culture Primary human ethical principles based on the European culture Tolerance, respect and equal opportunities Tolerance, respect and equal opportunities Openness Openness Trust Trust Innovation and creativity Innovation and creativity Professionalism and professional ethics Professionalism and professional ethics Team work Team work Transparency Transparency Perseverance and courage Perseverance and courage …and the determination to survive each day as it comes

15. Network of Services – working with a drug user is a process Prevention Centre Prevention Centre Low threshold centre Drop-in centre (inc. Club “Sklenik”) Low threshold centre Drop-in centre (inc. Club “Sklenik”) Street work/out reach (inc. Synthetic drugs prevention) Street work/out reach (inc. Synthetic drugs prevention) Prevention and HR Treatment Other services Day care “Elysium” (inc. Methadone programme) Day care “Elysium” (inc. Methadone programme) Psychiatric clinic Psychiatric clinic Therapeutic community Therapeutic community After-care centre After-care centre Skills learning and supporting enployement Skills learning and supporting enployement I.E.S. (Institute for Education and Supervision) I.E.S. (Institute for Education and Supervision) Drug services in prison Drug services in prison Skills learning center Skills learning center Pastoral (spiritual) care Pastoral (spiritual) care

16. Professor Michael Gossop MD “The urgent need to respond to the threat of HIV and AIDS has radically altered the drugs agenda. The rhetoric of United States and some other countries may continue to promote the discredited ideals of the “war against drugs” and “zero tolerance”, but living with drugs has now become an imperative.”